Provider Demographics
NPI:1669963484
Name:LEE, JUSTIN MARK (DPT)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MARK
Last Name:LEE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:277 WILSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1037
Mailing Address - Country:US
Mailing Address - Phone:650-922-9150
Mailing Address - Fax:
Practice Address - Street 1:277 WILSHIRE AVE
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1037
Practice Address - Country:US
Practice Address - Phone:650-922-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT294780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist